The clinical, radiographic, and electrocardiographic correlates of childhood pericardial effusion diagnosed with echocardiography

Background: Pericardial effusion (PE) is best detected with echocardiography. In settings where echocardiography is unavailable, other methods are relied on to diagnose PE.Objective: To evaluate the clinical, radiologic, and electrocardiographic (ECG) correlates of PE in children with echocardiographically detected PE.Methods: Children referred for echocardiography over a 4 year period at the University of Benin Teaching Hospital, were recruited if they also had PE. The clinical features, chest radiographic, and ECG findings were correlated with echocardiographically determined PE size using Spearman's correlation test. Statistical Package for Social Sciences (SPSS) 16 was used in the analysis of data.Results: Of the 1,023 echocardiograms, 54 (5.2%) had PE. The mean age was 66.4 ± 53.4 months with 27 (50.0%) being males. PE was incidentally detected echocardiographically in 48 (88.89%) children. PE was mild, moderate, and severe in 12 (22.2%), 25 (46.3%), and 17 (31.5%), respectively. Of the 40 (74.1%) children managed in our center, 32 (80.0%) had heart failure. Four (10.0%) and six (15.0%) children, respectively had clinical tamponade and distant heart sound. Of the 15 cases with globular heart silhouette on chest radiograph, 12 (80%) had severe PE. Low voltage on ECG was seen in six (15.0%) children, who all had severe PE. Cases with distant heart sound, cardiomegaly on chest radiograph, and low voltages on ECG were significantly positively correlated with more severe PE, ρ, and (P-values), respectively were 0.49 (<0.0001), 0.54 (<0.0001), and 0.40 (0.005). There were five deaths of which two had shock from tamponade.Conclusion: Childhood PE is commonly caused by diseases causing heart failure. Clinical evaluation, ECG, and radiographic findings are not sensitive in identifying mild and moderate PE, while mortality is high in cases of tamponade.